Northern Ireland Experience Research Articles

From Stormont to Strasbourg – militant democracy in consociations

ABSTRACT This article joins the nascent literature exploring the nexus of consociational power-sharing and militant democracy. While the two ideas appear to be different answers to different challenges, the respective empirical research agendas have been converging with militant democratic scholarship’s increasing interest in ethnically and religiously divided societies. Besides analysing the relationship between the two concepts, the article reviews the militant democratic provisions in various contemporary consociations, with a particular focus on Northern Ireland, the jurisdiction with the most explicit arrangements on restrictive measures protecting its democratic procedures. Given the similarities between the Northern Irish arrangement and the European Union’s procedures allowing the suspension of member states in the European Council, as well as its partially consociational features, the article also stresses the question whether the experience of Northern Ireland can offer any lessons for proponents of militant democracy in the EU. In the latter regard, the analysis suggests that the consociational experience can prove the most useful concerning the articulation of norms and arrangements on the arbitrational bodies. Nevertheless, this explorative comparative research also invites further contributions to this field of research, especially on the contextual analysis of individual cases.

Primary hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN1): the northern ireland (NI) experience

Primary hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN1): the northern ireland (NI) experience

Suspected cancer (red flag) referrals: A review of our experience in Northern Ireland

AbstractAimHead and neck cancer continues to represent a significant source of morbidity and mortality for patients. Alongside prevention, early recognition is key to improving patient outcomes. We aim to present our experience of suspected cancer referrals to the oral surgery/oral medicine units within a dental hospital in Northern Ireland in terms of patient demographic, referral quality, and referral outcome.Materials and MethodsPatients who were referred to the oral surgery or oral medicine departments within the Queen's University Belfast Dental hospital between January and September 2018, and placed on the suspected cancer (Red Flag) pathway, had their records reviewed. Data was extracted by 2 calibrated dentists using predetermined data extraction forms.ResultsOverall, 377 patient referrals were identified with the majority coming from dentists (GDPs) and general practitioners (GMPs). GMP referrals were commonly via the e‐referral system (97%), and GDP via post or email (97%). E‐referrals underwent triage faster than other referral methods. Of the original referrals, 62% remained on the red flag pathway following consultant triage, and all were allocated appointments within 2 weeks. Ulcers, swellings, and white patches were the most referred lesions with just 5.5% of referrals including clinical photographs. Overall, positive predictive value (PPV) was 5.3% (8% for GDPs and 3% for GMPs).ConclusionOur department successfully met the 2‐week target in all cases. PPV does however remain low, but within recognised guidance limits, and could potentially be improved by further education of referrers and/or inclusion of a clinical photo at the time of referral.

Coproduction with Service Users in Adult Social Work: A Study of Service Users’ and Social Workers’ Experiences in Northern Ireland

Abstract Involving service users, in the delivery of health and social care, is a focal point in social policy discourse. Coproduction has become synonymous with anti-oppressive practice and service user empowerment. This article reports on a qualitative study carried out in Northern Ireland which explored service user involvement in adult social care practice and policy development. Semi-structured interviews were completed with service users (n = 6) and social workers (n = 7); thematic analysis was applied to the resultant data. The study was coproduced with service users who informed the research design and were actively involved throughout each phase of the study. Findings suggest that service users are motivated to participate in coproduction and can feel valued in these roles, but meaningful coproduction is a challenge in the current practice environment. Close working relationships, with clear and consistent communication are difficult to maintain amid the current trend of bureaucratisation in our profession. Findings point towards the need for a service-user/social worker alliance which can challenge problematic organisational cultures. Remuneration for service users, engaged in coproduction, is encouraged, alongside organisational recognition of the time and resource necessary for effective coproduction. A procedural and ethical framework for coproduction practices would also be timely.

A Retrospective Evaluation and Review of Radiographic Outcomes for Anterior Cervical Discectomy and Fusion (ACDF) Procedures: Northern Ireland's Experience.

Introduction Anterior Cervical Discectomy and Fusion (ACDF) is the gold standard treatment for symptomatic cervical spondylosis refractory to analgesic medical management. Currently, there are numerous approaches and devices used; however, there is no single implant that is preferred for this procedure. The aim of this study is to evaluate the radiological outcomes of ACDF procedures performed in the regional spinal surgery centre in Northern Ireland. The results of this study will aid surgical decision-making, specifically with regard to the choice of implant. The implants that will be assessed in this study are the stand-alonepolyetheretherketone (PEEK)cage (Cage) and the Zero-profile augmented screw implant (Z-P). Methods A total of 420 ACDF cases were reviewed retrospectively. Following exclusion and inclusion criteria, 233 cases were reviewed. In the Z-P group, there were 117 patients, with 116 in the Cage group. Radiographic assessment was carried out at the pre-operative stage, day one post-operation, and follow-up (> three months). Measured parameters included segmental disc height, segmental Cobb angle, and spondylolisthesis displacement distance. Results Patient characteristic features showed no significant difference between the two groups (p>0.05) and no significant difference in mean follow-up time (p=0.146). The Z-P implant was superior in increasing and maintaining disc height post-operatively (+0.4±0.94mm, 5.20±0.66mm) compared to the Cage (+0.1±1.00mm, 4.40±0.95mm) (p<0.001). Z-P was also more successful in restoring and maintaining cervical lordosis in comparison to the Cage group, as it had a significantly smaller kyphosis incidence (0.85% vs. 34.5%) at follow-up (p<0.001). Conclusions Results of this study show a more advantageous outcome in the Zero-profile group as it restores and maintains both disc height and cervical lordosis; it is also more successful in treating spondylolisthesis. This study advocates cautious endorsement of the use of the Zero-profile implant in ACDF procedures for symptomatic cervical disc disease.

Building a Research Community to Bring Evidence into Practice: Case Study

Abstract This case study drawn from our collective experience in Northern Ireland presents a relatively unique approach that considers the role of wider contextual and organisational factors in supporting or inhibiting research into social work and social care practice. It has been written by members of the Building A Research Community Group (hereafter referred to as Research Community) established in 2019. The Research Community was built on the premise that partnership and co-production working between service delivery organisations, researchers and academia, and service users and carers is an essential underpinning to effective ‘practitioner research’, just as it is to the development of robust practitioner-relevant education and training. Using our experience over the last decade, we argue that bridging the gap between scientific evidence and practice requires leadership and the development of a supportive organisational culture that is receptive to learning and change. Highlighting both successes and challenges, along a journey spanning from 2014, we focus on the importance of developing a research strategy and realistic implementation plan accompanied by resource allocation. By sharing our journey in this case study, we hope that others across other geographical contexts can learn from our experience and are encouraged to share their own experiences.

Stuck between the EU ‘rock’ and UK ‘hard place’? Northern Ireland as a liminal space after Brexit

ABSTRACT Northern Ireland hardly featured as an issue in the historic 2016 Brexit referendum campaign in the UK. Subsequently, however, it became the main zone of contention between the EU and UK. This article examines Northern Ireland's experience since the Brexit vote through the theoretical lens of liminality. It does so, specifically, by focusing on the three strands of relationships at the heart of Northern Ireland's 1998 peace agreement, and how Brexit impacted on each of these relationships. It argues that Brexit proved profoundly unsettling to the existing political order and triggered significant angst and fear in Northern Ireland.

Combined panniculectomy and surgical staging of endometrial cancer: the Northern Ireland experience

Background: Endometrial cancer is the most common gynaecological malignancy in the Western world and has a strong association with obesity. The incidence of endometrial cancer is rising and can be attributed, in part, to the ongoing obesity epidemic. The surgical management of endometrial cancer in women with class III obesity, defined as those with a body mass index (BMI) ≥40 kg/m2, can be particularly challenging. Case(s): We report the early experience of panniculectomy as an adjunct to endometrial cancer staging surgery in Northern Ireland (NI). We outline the generic surgical approach and report the outcomes of the first four cases undertaken. We discuss the important role that panniculectomy holds in the surgical management of endometrial cancer in women with III obesity. Conclusion: The initial experience, in NI, of panniculectomy as an adjunct to endometrial cancer staging surgery greatly facilitated surgical exposure and allowed adequate surgical staging to be performed. In carefully selected cases, the surgical procedure can be completed safely and effectively with greater ease.

P-P58 The role of PET-CT in the management of pancreatic cancer. A Northern Ireland experience

BackgroundDiagnosis and staging has proven to be difficult in 10-20% of patients with pancreatic cancer. The PET-PANC study found that PET-CT significantly influenced the staging and management of pancreatic cancer and therefore the NICE guidelines now advise PET-CT in all patients who have localised potentially resectable disease. This study aimed to investigate the impact of PET-CT on the management of pancreatic cancer patients in a single tertiary referral centre.MethodsThere were 288 patients with pancreatic cancer discussed at the Northern Ireland Regional Hepatobiliary MDM from January 2020 to March 2021. Of these patients, 176 were deemed to have inoperable disease based on initial CT, 5 had borderline resectable disease, 1 had holding chemotherapy due to COVID restrictions and 57 were excluded from surgical resection for a variety of reasons. These included the patient being unfit for surgery, the patient declining operative intervention and an alternative treatment offered as result of COVID-19 pandemic. Therefore, there were 49 patients with pancreatic adenocarcinoma which the MDT concluded should be considered for surgical resection.ResultsA total of 27 patients who were due to undergo a curative resection had a pre-operative PET-CT scan (55.1%). This demonstrated metastatic disease in 9 cases (33.3%). Four patients who did not have a preoperative PET-CT were found to have metastatic disease at operation (9.7%). This equated to a total metastatic incidence of 26.5% in those who had been initially deemed resectable based on CT scan alone. The time interval from MDM decision to surgery averaged 25.4 days in those who did not have a PET/CT compared to 40.43 days in those who did. This was an average delay of 15.07 days until treatment.ConclusionsThis study demonstrates the important role the PET-CT has in the management of patients with pancreatic cancer. A significant number of patients avoided an unnecessary operation which would have delayed the commencement of chemotherapy. However, there are limitations to PET-CT, demonstrated in the patient with an inconclusive result, who was found to have liver metastases at surgery. The introduction of PET-CT in the staging process does undoubtedly cause delays to surgical resection and a more streamlined pathway needs to be developed to limit the delay to curative treatment.

Derry girls and the politics of the everyday: theorising for a more youth-inclusive approach to peacebuilding

ABSTRACT The popular sitcom Derry Girls is a witty take on director Lisa McGee’s adolescent experience in Northern Ireland during the Troubles. While set in an era of exceptional sectarian violence, Derry Girls showcases the ways that conflict becomes entangled within mundane, everyday life and how young people are profoundly affected by conflict yet are continually excluded from conflict-related decision-making. I draw on Derry Girls to unpack the theoretical framework offered by Berents and McEvoy-Levy that seeks to include young people more intentionally in peacebuilding. This paper offers credence to a movement that defines peacebuilding differently than the state-centric and elite-driven model that has predominated peace and conflict studies, and instead follows the important contributions of sociological perspectives to the field. I argue that a more youth-inclusive approach to peacebuilding requires re-examining the very concepts that underpin ‘youth’ and ‘peacebuilding’ and the barometers by which successful peace is measured.

Efficacy of TIP (paclitaxel, ifosfamide and cisplatin) as salvage chemotherapy for relapsed germ cell cancer patients stratified by the modified International Prognostic Factors Study Group (IPFSG) score: The Northern Ireland (NI) Experience.

5028 Background: Salvage therapy for relapsed or refractory germ cell tumours (GCTs) after first-line treatment (1LT) failure remain controversial. The ongoing TIGER trial aims to compare conventional-dose chemotherapy (CDCT) using TIP with high-dose chemotherapy (HDCT) and to validate a modified version of the IPFSG stratification system as a secondary objective. We retrospectively analysed data from patients treated with TIP at our institution and stratified by the modified IPFSG (mIPFSG) groupings, correlating this with clinical outcomes. Methods: Data from all GCT patients who received TIP in NI between 2005 and 2014 was collected. Patients were scored using known IPFSG factors including progression-free interval (0-1), metastasis site (0-3), response to 1LT (0-2), primary tumour site (0-3), HCG (0-1), AFP (0-2), and histology (-1 to 0), and categorised into the modified strata. Descriptive and inferential statistics using SPSS compared survival measure outcomes and the favourable response rate (FRR) i.e the proportion of patients achieving either a complete response or partial response with normal serum tumour markers, according to mIPFSG group. Results: Thirty patients were identified, all of whom received 4 cycles of TIP. The median age was 37 years (range 17-57), 28 patients were non-seminoma histology with 2 patients seminoma. The cohort comprised predominantly of patients with more adverse mIPFSG features and the FRR of the group was 30%, with a median progression-free survival (PFS) of 9 months and 2-year overall survival (OS) of 50%. Clinical outcomes differed by mIPFSG score as shown below. Conclusions: Our study shows TIP efficacy comparable to published data, and to our knowledge is the first to show correlation between clinical outcomes with the regimen and the new mIPFSG model. The differences in outcomes to CDCT using TIP across risk groups in real world practice shows potential for a stratified approach to patient selection for salvage therapy, as is under investigation by the TIGER study.[Table: see text]

Bovine tuberculosis breakdown duration in cattle herds: an investigation of herd, host, pathogen and wildlife risk factors.

BackgroundDespite rigorous controls placed on herds which disclose ante-mortem test positive cattle to bovine tuberculosis, caused by the infection of Mycobacterium bovis, many herds in Northern Ireland (NI) experience prolonged breakdowns. These herds represent a considerable administrative and financial burden to the State and farming community.MethodsA retrospective observational study was conducted to better understand the factors associated with breakdown duration, which was modelled using both negative binomial and ordinal regression approaches.ResultsSix explanatory variables were important predictors of breakdown length in both models; herd size, the number of reactors testing positive in the initial SICCT test, the presence of a lesioned animal at routine slaughter (LRS), the count of M. bovis genotypes during the breakdown (MLVA richness), the local herd-level bTB prevalence, and the presence of herds linked via management factors (associated herds). We report that between 2008 and 2014, mean breakdown duration in NI was 226 days (approx. seven months; median: 188 days). In the same period, however, more than 6% of herds in the region remained under movement restriction for more than 420 days (13 months); almost twice as long as the mean. The MLVA richness variable was a particularly important predictor of breakdown duration. We contend that this variable primarily represents a proxy for beef fattening herds, which can operate by purchasing cattle and selling animals straight to slaughter, despite prolonged trading restrictions. For other herd types, the model supports the hypothesis that prolonged breakdowns are a function of both residual infection within the herd, and infection from the environment (e.g. infected wildlife, contiguous herds and/or a contaminated environment). The impact of badger density on breakdown duration was assessed by including data on main sett (burrow) density. Whilst a positive association was observed in the univariate analysis, confounding with other variables means that the contribution of badgers to prolonged breakdowns was not clear from our study. We do not fully reject the hypothesis that badgers are implicated in prolonging bTB breakdowns via spillback infection, but given our results, we posit that increased disease risk from badgers is unlikely to simply be a function of increasing badger density measured using sett metrics.

과태료 집행 제도 개선을 위한 법제도적 전략 - 북아일랜드와 스코틀랜드의 경험을 참고하여 -

과태료는 행정법적 수준에서의 의무위반에 대한 제재, 특히 대표적인 행정질서벌이다. 특히 이는 형벌 외의 제재로 구분되기 때문에 형법총칙과 형사소송법 등 형벌에 적용되는 법규의 적용으로부터 자유로운 제재로 인정받고 있는 것이 특이하다. 위반의 정도가 심하지 않은 행정법규 위반행위에 대하여 당해 과태료를 부과하는 것이 일반적이라는 것 또한 어렵지 않게 상정할 수 있음은 물론이다. 하지만 문제는 당해 지점에서 과태료 집행에 있어서의 딜레마를 어렵지 않게 발견할 수 있다는 것이다. 언급한 바와 같이 과태료를 부과하는 대상행위의 행정법규 위반 정도가 심하지 않다는 점을 고려한다면 이에 대한 규제의 수준 역시 과중하도록 유도하는 것이 어려운 것이 사실이다. 그렇다면 과태료의 집행 수준 역시 실제로 과중하게 설정하는 것에는 상당한 부담이 존재하는 것이다. 과태료 징수의 효과적인 집행을 위하여 과태료 액수의 상향을 고려하는 것이 쉽지만은 않은 이유가 여기에 있는 것이다. 그렇다면 행정질서벌로서의 과태료를 행정형벌로 전환하는 것을 고려해볼 수 없는 것은 아니지만 현재 비범죄화를 위한 노력이 보편적으로 경주되고 있는 것을 상기하면 당해 방안의 실효성 역시 장담할 수만은 없다. 결국 간접적 행정질서에 위해를 가하는 행위에 가하는 과태료 제도의 존재 의의를 부인할 수 없다면 당해 과태료 제도의 효과적인 운영을 위한 방안, 특히 이의 징수율을 확보하는 방안이 무엇보다 중요하다고 할 수 있다는 점에서 과태료 제도의 실효적인 운영을 위해서는 무엇보다 과태료 집행의 실효성 제고 방안이 무엇인지에 대한 고민이 있어야 한다.BR 영국은 이를 위하여 차량 압류 절차를 적극 활용하고 있다. 즉 FEO라고 불리는 집행관과 contractor라고 불리는 담당관은 과태료 미납자에 대하여 압류명령을 직접적으로 집행하는 역할을 담당하고 있으며 당해 절차를 통하여 종국적으로 미납된 과태료를 충당하여 과태료본래의 목적으로 어렵지 않게 달성하고 있다. 물론 당해 절차는 상당 정도 면밀하게 도모되고 있으며 각 단계별로 당사자에게 이의신청 기회를 주는 등 당사자의 권리 보장에도 만전을 기하고 있다. 우리 역시 과태료 징수율의 제고에 난항을 겪고 있어서 과태료 제도의 제도적 의의를 확보하기 위해서는 우선 과태료 징수 혹은 집행절차의 개선이 도모되어야 한다. 특히 경미한 법위반에 대하여 부괴되는 과태료의 제도적 의의를 고려한다면 자동차 압류 절차는 우리에게도 시사하는 바가 상당하며 특히 우리는 질서위반행위규제법을 통하여 과태료에 대한 전반적인 사항이 도모되고 있다는 점에서 당해 법률에 관련 사항을 규정할 수 있을 것이다.

Recognition – The First Step to More Human Relationships

AbstractIn this paper I draw on my working experience in Northern Ireland and elsewhere, and reflect on how relationships between communities of people who are different, whether by color or from culture, often demonstrate deep difficulties as a result of longstanding, painful traumas. Humiliation, disrespect and unfair treatment of a community can be key factors in causing conflict and violence. I believe the way forward is to recognize each other as communities of real human beings who have their own thoughts, feelings, culture, background and hopes for the future. Then, there needs to be a progression toward respecting each other as individual human beings and as communities. Respect can then be entrenched in rights, and so violence and trauma can be reduced. The fundamental aim however is to create new and better relationships, not merely to put new legal commitments and regulations in place.

77 - A retrospective audit of adjuvant chemotherapy in stage 1b–3b non-small cell lung cancer: the Northern Ireland experience 2004–2017

77 - A retrospective audit of adjuvant chemotherapy in stage 1b–3b non-small cell lung cancer: the Northern Ireland experience 2004–2017

22P - Ipilimumab for advanced melanoma in the real world: The Northern Ireland experience

22P - Ipilimumab for advanced melanoma in the real world: The Northern Ireland experience

Integrated Care Policy in Ireland: A Comparative Review

Introduction: Literature reveals that integrated care is perceived to be the answer to the many issues faced by health systems in in the OECD. Research has also identified many difficulties in its implementation1. In Ireland, it has been observed that there is a disconnect between the trend of patient centred policy making and the organisational support available to health professionals and patients at the frontline in its implementation. Description of Policy context and Objective: The context for this paper is the introduction of integrated care in Ireland through the implementation of Community Health Organisations (CHOs) in 2015/16 as outlined in the report– Report and Recommendations of the Integrated Service Area Review Group’ also referred to as the Healy Report (HSE 2014). A similar policy development was introduced in Northern Ireland since 2011; with the development of an integrated health and social care policy (Transforming Your Care, Review of Health and Social Care, 2011). This paper reports on a comparative review of integrated health and social care policy in both Ireland and Northern Ireland and identifies themes that emerge from a comparative policy document analysis. It examines the contents and specific aspects of both sets of policy documents including; implementation plans, structures and governance arrangements and their potential influence on professional practice. This paper will serve as a contribution to a future study on the process of implementation of integrated care in the Republic of Ireland. Highlights: Northern Ireland has implemented structural integration of its health and social care since the 1970s. Existence of similarity in policy goals and objectives, the reform programmes, guiding principles and agenda’s set out in policy documents in Northern Ireland and Republic of Ireland. The Republic of Ireland runs a risk of facing the same policy issues observed in the Northern Ireland experience of implementation based on policy recommendations. Sufficient resources need to be in place in order to have sustainable integrated care in the Republic of Ireland. Transferability: This paper describes the relevance of Northern Ireland experience and serves as a useful guide to the implementation of integrated health and social care in the Republic of Ireland. onclusion: (Key findings, discussion and lesson learned) The main themes that emerged from the comparative review include; policy process, structural composition, governance, management and accountability, clarity of professional roles and policy goals, localism agenda and standardised pathways, frontline autonomy and decision making, stakeholder inclusion and configuration. Implementing integrated care is expensive, requires balanced configuration of management, structures and governance arrangements that supports exchange of information across professionals, shared services, involvement of users, promotion of strong working relationships and collaborations as well as more research in bridging gaps between policy aims and frontline professional practice which on the long run produces sustainable health delivery outcomes.

No solution: the Labour government and the Northern Ireland conflict, 1974–79

The ‘British’ experience in Northern Ireland made political and military policy-makers cautious of becoming more deeply involved in the war in Yugoslavia 1991–5. The conflict appeared, at that point, to be getting worse rather than better. The Irish Republican Army's (IRA) 1994 ceasefire and the peace process, leading to the Good Friday or Belfast Agreement of 1998, transformed perceptions. In the aftermath of the invasion of Iraq in 2003, the British military believed that they had a successful approach to counter-insurgency that drew on the experiences of Malaya and Northern Ireland. This optimism persisted and informed the deployment to Helmand in 2006. The memory of the complexity of the Northern Ireland conflict was erased and replaced with simplistic ‘lessons’, leading to disastrous consequences. Stuart Aveyard's informed and well-researched book reminds readers of the intractability of the Northern Ireland conflict. He states in the first sentence of the book: ‘In its broadest sense this is a book about the limitations of government power’ (p. 1). The British government could not have simply imposed a solution on Northern Ireland.

Normality unpacked: migration, ethnicity and Local Structure of Feeling among Polish migrant workers in Northern Ireland with a comparative perspective on Scotland

ABSTRACTPrevious literature on Polish migration to the UK identified a discourse of normality as a grand narrative in migrants’ justifications for living and working abroad. The present article contributes to this literature by asking what happens to this discourse in the circumstances of the UK, where it cannot be easily sustained. To explore this issue, the case of Northern Ireland is chosen and it is illustratively compared to that of Scotland. Using the concept of Structures of Feeling to frame the analysis of semi-structured interviews with Polish migrant workers, the study shows that, on the one hand, migration experience in Northern Ireland seems to undermine the ideal of a normal life as well as the idealised images of the UK that the discourse of normality conveys. However, it also shows that this discourse remains an important feature of migrants’ narratives. In accounting for this inconsistency within interviews, the article proposes the notion of ‘normality through exclusion’. It also shows that, although not straightforwardly different from the experience of migration to other parts of the UK, the experience of migration to Northern Ireland is also characterised by certain subtleties which are well accounted for by the concept of Structures of Feeling.

The Role of the Poet in a Time of Violence: A New Historicist Reading of Paul Muldoon’s “The More a Man Has the More a Man Wants”

The main aim of this paper is to examine how Paul Muldoon’s personal experience in a strife-torn Northern Ireland affects his selection of historical subjects and his fictional representation of them adopting the New Historicism theory. It begins with a brief background on the New Historicism theory and emphasises the notion that the new historicist theorists sought to reveal truths concealed by history and to re-read or re-inscribe the past as seen from a present perspective. Both history and society combine to give various meanings and multiple interpretations to literary texts, hence studying the socio-cultural backgrounds as well as the authorial intentions help re-inscribe the past, reconstruct the social, cultural and political issues, and refigure the individual identity. The paper concludes that there is no binary opposition between history and literature or context and text and that both are subjective representations of reality. Thick description is illustrated as one of the tools that help suggest a multiplicity of social and political implications and it is concluded that both literary and non-literary texts are fictions formulated by imagination and created according to the authorial intentionalism. The second part of the paper proves that Muldoon’s poetry is intentionally obscure to manipulate and baffle readers. The paper asserts that Muldoon’s poetic technique and fast-paced tone help in dedicating his willful obscurity. “The More a Man Has the More a Man Wants” delineates the hunger strikes prevalent as a kind of protest in Northern Ireland in the 1980s, revealing an ugly, unpalatable truth. Muldoon inscribes history in the images of the body. The hero’s transformations coincide with the poet’s changing of the traditional sonnet into a more flexible narrative form. The irregular metrical patterns, repetitions and transformations in theme and subject emphasise the fragmented identity the poet wants to reveal. Muldoon’s interest in intertextuality as a poetic technique helps him confirm that official history can be fictionally re-structured and that the reader is responsible for interpreting the authorial intentionalism.